Evaluation and Comparison of Patients Poisoned with Acetaminophen and Nonsteroidal Anti-Inflammatory Drugs

We aimed to determine and compare the clinical and demographical features, treatments, follow-up, poisoning scores and outcome of cases with the acetaminophen and NSAIDs intoxication. Data of the patients who were at the age of 18 and older and applied to the Emergency Department with the acetaminophen or NSAIDs intoxication were retrospectively examined. The cases were divided into 2 groups as the acetaminophen and NSAIDs group. The cases‟ age, gender, drug dose, hospitalization status and periods, poisoning scores (PSS, APACHE-II) and last conditions in discharging from the hospital were compared. The döşe was taken by 99 (55%) patients in the acetaminophen group was calculated as toxic, and intravenous acetylcysteine was administered to 70 (38.9%) patients as an antidote. When the APACHE-II scores of the patients hospitalized in the intensive care unit were examined, the mean APACHE-II score of 54 patients in the acetaminophen group was 3.15±3.70, the mean APACHE-II score of 34 patients in the NSAIDs group was 4.15±3.13 and it was statistically higher (p=0.031). All the patients followed-up in both groups were discharged with healing except only 1 (0.6%) patient who developed acute liver failure. Conclusion: The mean APACHE-II score was low in both groups. Therefore, following-up the patients in a unit such as a toxicology unit instead of the intensive care unit can be beneficial in terms of both reducing the place and labor force loads and cost. Moreover, the acetylcysteine treatments in the early period of the acetaminophen toxicity are very effective in decreasing the mortality and morbidity.

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1. Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother 2010; 44: 489-506.

2. Paulose-Ram R, Hirsch R, Dillon C, et al. Prescription and non-prescription analgesic use among the US adult population: results from the third National Health and Nutrition Examination Survey (NHANES III). Pharmacoepidemiol Drug Saf 2003; 12: 315-326.

3. Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. Annual Report of the American Association of Poison Control Centers‟ National Poison Data System (NPDS): 33rd Annual Report. Clinical Toxicology 2015; 54: 924-1109.

4. Chung EY, Tat ST. Nonsteroidal antiinflammatory drug toxicity in children: a clinical review. Pediatric emergency care 2016; 32: 250- 253.

5. Burke A, Smyth E, FitzGerald GA. Analgesicantipyretic and antiinflammatory agents; pharmacotherapy of gout. Goodman & Gilman‟s The Pharmacological Basis of Therapeutics. 11th edn. McGraw Hill, San Diego, CA 2005; 671-716.

6. Masso Gonzalez EL, Patrignani P, Tacconelli S, et al. Variability among nonsteroidal antiinflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum 2010; 62: 1592-1601.

7. Larson AM, Polson J, Fontana RJ, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005; 42: 1364-1372.

8. Hinson JA, Roberts DW, James LP. Mechanisms of acetaminophen-induced liver necrosis. Handb Exp Pharmacol 2010; 369-405.

9. Antoine DJ, Jenkins RE, Dear JW, et al. Molecular forms of HMGB1 and keratin-18 as mechanistic biomarkers for mode of cell death and prognosis during clinical acetaminophen hepatotoxicity. J Hepatol 2012; 56: 1070-1079.

10. Lancaster EM, Hiatt JR, Zarrinpar A. Acetaminophen hepatotoxicity: an updated review. Arch Toxicol 2015; 89: 193-199.

11. Schmidt LE, Dalhoff K. Risk factors in the development of adverse reactions to N‐acetylcysteine in patients with paracetamol poisoning. British journal of clinical pharmacology 2001; 51: 87-91.

12. Kirschner RI, Rozier CM, Smith LM, Jacobitz KL. Nomogram line crossing after acetaminophen combination product overdose. Clinical toxicology 2016; 54: 40-46.

13. James LP, Letzig LG, Simpson PM, et al. Pharmacokinetics of acetaminophen protein adducts in adults with acetaminophen overdose and acute liver failure. Drug Metabolism and Disposition 2009.

14. Park BK, Dear JW, Antoine DJ. Paracetamol (acetaminophen) poisoning. BMJ clinical evidence, 2015.

15. Kumar RD, Premnath U. Novel Regimens in the Treatment of Paracetamol (Acetaminophen) Poisoning. The Journal of the Association of Physicians of India 2017; 65: 71-78.

16. Unzueta A, Vargas HE. Nonsteroidal antiinflammatory druginduced hepatoxicity. Clin Liver Dis. 2013; 17: 643-656.

17. Bessone F. Non-steroidal anti-inflammatory drugs: What is the actual risk of liver damage? World J Gastroenterol 2010; 16: 5651-561.

18. Taneja S, Kumar P, Rathi S, et al. Acute Liver Failure Due to Etodolac, a Selective Cycloxygenase-2 (COX-2) Inhibitor NonSteroidal Anti-Inflammatory Drug Established by RUCAM-Based Causality Assessment. Annals of hepatology 2017; 16: 818-821.

19. Ali S, Pimentel JD, Ma C. Naproxen-induced liver injury. Hepatobiliary & Pancreatic Diseases International 2011; 10: 552-556.

20. Donati M, Conforti A, Lenti MC, et al. Risk of acute and serious liver injury associated to nimesulide and other NSAIDs: data from drug‐induced liver injury case–control study in Italy. British journal of clinical pharmacology 2016; 82: 238-248.

21. Persson HE, Sjöberg GK, Haines JA, de Garbino JP. Poisoning severity score. Grading of acute poisoning. Journal of Toxicology: Clinical Toxicology 1998; 36: 205-213.

22. Banderas-Bravo ME, Arias-Verdú MD, MacíasGuarasa I, et al. Patients admitted to three Spanish intensive care units for poisoning: type of poisoning, mortality, and functioning of prognostic scores commonly used. BioMed research international 2017.

23. Godinjak A, Iglica A, Rama A, et al. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta medica academica 2016; 45: 97- 103.

24. Lee H, Lim CW, Hong HP, et al. Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients. Anaesthesia and intensive care 2015; 43: 175-186.